Objectives study frequency and nature of atherosclerotic damage of extracranial arteries (ECA), coronary arteries (CA), leg arteries (LA) and associated symptoms in patients (pts) with systemic lupus erythematosus (SLE).
Methods Study included 100 pts with SLE (90 women and 10 men) aged 18 - 66 (mean 40,9±1,4) with disease history of 1 - 43 years (mean 9.93±0.88 years). All pts underwent duplex ultrasound (DU) of carotid, vertebral, iliac, femoral, popliteal and tibial arteries and abdominal aorta. Atherosclerosis(AS) was confirmed if intima-media thickness (IMT) was ≥0,8 mm or atherosclerotic plaques (AP) were present. Multidetector computed tomography (MDCT) was used for CA calcification detection, and the result was regarded as positive when calcium index exceeded 10. The control group (CG) consisted of 32 apparently healthy pts (26 women and 6 men, mean age 38,4±2,4 years).
Results AS in ECA was found in 41 (41%) SLE pts, and this incidence was 3.3-fold higher vs CG. 9 pts had IMT increase only, 17 – IMT increase in combination with AP, 15 - AP and normal IMT. AP were found in the common carotid (27 pts) and internal carotid (17 pts) arteries, but not in the vertebral arteries. 37,5% of pts with AP in ECA had artery narrowing up to 50% (none with >50% narrowing). Clinical symptoms that could be associated with AS of cerebral arteries (includingTIA/strokes) were present in 63,4% of pts with ECA AS.
LA AS symptoms were found in 58 (58%) pts- 3.7-fold higher incidence vs CG. 3 pts had IMT increase only, 21 – IMT increase with AP, 34 - AP and normal IMT.AP were visualized in all the examined areas of LA, most often, in tibial arteries (40% pts), and almost twice as less in the abdominal aorta, common femoral and popliteal arteries. Isolated damage of LA distal areas was present 2.7 times more often vs proximal.41,8% of pts with AP presented 10% to total occlusion stenosis, 18,2% - >50% stenosis. Clinical symptoms that could be associated with hypoperfusion of the leg were found in 79,3% pts with LA AS, while critical stenosis/occlusion of the arteries was present in all pts with intermittent claudication.
CA calcification was found in 39 (39%) pts - 4.2-fold higher incidence vs CG. Most often, AP were located in the left main artery (66,7% from 39) and left anterior descending artery (51,3%), more rarely – in the left circumflex (12,8%) and right CA (10,3%). Clinical symptoms of the ischemic heart disease were presented by 11 pts: effort angina – 10, old myocardial infarction – 6, 5 of whom had angina pectoris.
In general, AS, at least in one system of artery, was found in 66,0% pts. LA AS incidence was higher vs ECA (p <0.05) and CA (p <0.01). Isolated damage of one system of artery was observed in 31,8% of pts, two systems - 27.3% (in all cases involving LA), all three systems - 40,9%. Most often, AS was found in one artery (21,2%), and all other pts had 2 – 11 (mean – 4) arteries affected.
Conclusions High AS incidence (66%), which is 3,5-fold higher than in apparently healthy people, is typical for SLE. Most often, AS evidence is found in LA, and in 77.6% cases that is combined with ECA and/or CA damage. Isolated ECA and CA damage without LA involvement are observed only in 5% and 3% of pts respectively. Clinical symptoms of AS at different localizations are present in 28,2% - 79,3% of pts.
Disclosure of Interest None Declared
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